When an imbalance occurs, PUD might develop.
Helicobactor pylori
H. pylori→ ? →ulceration
Prevalence of H. pylori: 80% in developing area; 20-50% in developed area
Etiology
A peptic ulcer is a mucosal break, 3 mm or greater, that can involve the stomach or duodenum.
The most important contributing factors are H pylori, NSAIDs, acid, and pepsin.
Additional aggressive factors include smoking, ethanol, bile acids, aspirin, steroids, and stress.
Important protective factors are mucus, bicarbonate, mucosal blood flow, prostaglandins, hydrophobic layer, and epithelial renewal. Increased risk when older than 50 d/t decrease protection
The rate of H. pylori infection is declining in developed country
Transmission: oral → oral fecal → oral
Helicobactor pylori
It is possible that the different disease related to H. pylori infection can be attribute to different strains of organism with distinct pathogenic features
In the US:
Lifetime prevalence is ~10%. PUD affects ~4.5 million annually. Hospitalization rate is ~30 pts per 100,000 cases. Mortality rate has decreased dramatically in the past 20 years
approximately 1 death per 100,000 cases
Comparing Duodenal And Gastric Ulcers
Epidemiology (DU)
Duodenal sites are 4x as common as gastric sites Most common in middle age
Helicobactor pylori
NSAID
NSAID→COX →PG↓
The form of NSAIDs have no relation to their damage on GI mucosa !!
NSAID
factor:
Advanced age History of ulcer Concomitant use of glucocorticoids Concomitant use of anticogulants Serious or multi-system disease H. pylori infection Cigarette and/or alcohol consumption
Peptic Ulcer Disease (PUD)
Definition
A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.
peak 30-50 years Male to female ratio—4:1 Genetic link: 3x more common in 1st degree relatives More common in patients with blood group O Associated with increased serum pepsinogen H. pylori infection common
up to 95% Smoking is twice as common
Gastric Ulcers
Common in late middle age
incidence increases with age
Male to female ratio—2:1 More common in patients with blood group A Use of NSAIDs - associated with a three- to four-fold
(Uphold & Graham, 2003)
Peptic ulcers: Gastric and Duodenal
PUD Demographics
Higher prevalence in developing countries
H. Pylori is sometimes associated with socioeconomic status and poor hygiene
increase in risk of gastric ulcer Less related to H. pylori than duodenal ulcers – about
80% 10 - 20% of patients with a gastric ulcer have a
concomitant duodenal ulcer Malignancy